Cutaneous anthrax in patient with type 2 diabetes mellitus

Anthrax is a zoonotic disease caused by Bacillus anthracis, which is transmitted to humans from infected animals. Transmission occurs when there is a contact with animals or products from animals infected with anthrax. Anthrax infection is an important public health problem in developing countries. Indonesia is one of the countries where zoonotic anthrax forms can still be found. The most common entrance route for anthrax spores is the skin. Although skin anthrax usually resolves on its own, complications can arise in untreated cases. Underlying systemic disorders such as diabetes mellitus can disrupt the clinical picture and cause atypical presentation. A 50-year-old woman who works as a farmer with a history of diabetes mellitus, is treated at a local hospital with complaints of fever and inflamed lesions in the lower right leg. An anthrax outbreak has been reported in the area where she lives. At clinical examination regional swelling was found and the appearance of blackish lesions accompanied by pus around the wound. Laboratory tests documented by ELISA an increased titer of anthrax antibodies. The patient was given antibiotic therapy with a combination of penicillin G and ciprofloxacin intravenously and experienced healing from skin lesions. We can conclude that comorbid diseases such as diabetes mellitus can obscure clinical manifestations of skin anthrax and causes systemic symptoms. With appropriate management, skin anthrax lesions in patients with comorbid diabetes mellitus can heal with good results.